Mississippi and Minnesota on Opposite Ends of Healthiest-State Ranking

Action Points

Note that the obesity rate has doubled in the last 15 years and remains a major public health risk with nearly one in four people considered obese. Obesity is a risk factor for several chronic conditions including cardiovascular disease and diabetes.

Note that there have been improvements in areas such as prenatal care, infant mortality rates, immunizations, infectious disease incidence rates, cardiovascular disease rates, and even smoking prevalence. However, nearly 21% of the U.S. population continues to smoke and smoking remains a significant public health risk.

PHILADELPHIA, Dec. 14 - The overall health of Americans, which once improved by leaps and bounds, has slowed to a crawl, the result of obesity and poverty, according to a report issued here.

Minnesota was ranked in the report, America's Health Rankings2005, as the healthiest state in the nation, followed by Vermont, New Hampshire, Utah, and Hawaii.

Mississippi was on the bottom of the list of healthiest states, just behind Louisiana (49) and Tennessee (48).

The rate of improvement has dropped by 80% since the 1990s, according to the America's Health Rankings2005, the 16th annual report compiled by the United Health Federation, the American Public Health Association, and the Partnership for Prevention.

Over the past five years, the health of U.S. citizens improved only at an average rate of 0.3% each year. That's significantly down from the previous decade when during 1990s, the health of Americans had improved at an annual rate of 1.5% per year.

The report, which offered a mixed picture of both achievements and concerns, was presented at the American Public Health Association's annual meeting here. It was based on several public health factors, including smoking, infant mortality, disease, and immunizations.

Some of the biggest health challenges are the number of children living in poverty and obesity, noted the report. There are now more than one out of every four people considered clinically obese, a risk factor for cardiovascular disease, diabetes, and other chronic health problems. Obesity and children living in poverty each increased by 1% between 2004 and 2005, the report said. The obesity rate rose to 23.1% in 2005; the percentage of children under age 18 living in poverty also crept up to 17.8% in 2005.

"Our nation's slowing rate of improvement should be of concern to us all," said William McGuire, M.D., chairman of the United Health Federation's board of directors. "Failure to address this trend, and especially to decrease the risk factors that are associated with premature death and disease, will result in preventable misery and unnecessary death for too many Americans in the years to come."

The report also found other public health challenges. Disparities in health care between the states continue, with several states in the South struggling. Also, more people are going without health insurance and premature death increased slightly, by 0.02% in the past five years. Although that's not a significant increase, it's a shift from the 15% decrease that occurred from 1990 to 2000.

The report did not examine cause-and-effect. However, the authors said this slight increase in premature death is likely due to shifting socioeconomic factors, including fewer people with health insurance and more children living in poverty, and lifestyle factors, such as obesity.

The report also highlighted other obstacles. Among the other key findings:

Since 1990, there's been a doubling of the obesity rate, from 11.6% 15 years ago to 23.1% in 2005.

Over the past 15 years, there's been a 17% increase in the number of uninsured Americans, from 13.4% to 15.7%.

Disparities in cholesterol screening persist between states and between races. For example, 81% of Massachusetts' residents underwent cholesterol screening in the last five years compared with 64.5% of Hawaiians. When looking at race, disparities persisted within states themselves. For example, 70.9% of non-Hispanic whites in Ohio underwent cholesterol screening within the previous five years compared with only 56.5% of American Indians in the Buckeye state.

Twenty-nine states, including Tennessee, Oklahoma, and South Carolina, lag behind the national rate of improvement.

The report also revealed many successes:

Since 1990, motor vehicle deaths and infectious disease have each decreased by 40%.

Over the past 15 years, infant mortality has dropped by 34%, from 10.2 deaths per 1,000 live births to 6.7 deaths per live births.

There's been a 30% decline in smoking from 1990 to 2005. During the last year alone, from 2004 to 2005, there was a 6% drop in smoking prevalence. However, almost 21% of the U.S. population continues to smoke.

There's been an 18% decline in the rate of cardiovascular deaths from 1990 to 2005, from 406.3 deaths per 100,000 population to 332.9 deaths per 100,000.

Violent crime also decreased by 24% over this 15-year period, from 609 offenses per 100,000 population to 466 offenses per 100,000. There was a 6% decrease from 2004 to 2005 alone, with the violent crime rate dropping from 495 offenses per 100,000 population to 466 offenses per 100,000.

From 2004 to 2005, there was a 2% increase in immunizations among children ages 19 months to 35 months, from 79.4% to 80.9%.

The incidence of infectious disease decreased 6% from 2004 to 2005, from 26.1 cases per 100,000 population to 24.6 cases per 100,000.

There was a 5% increase in per capita public health spending from $154 per person to $162 per person for public health activities.

Prenatal care also increased by a slight 0.7% from 2004 to 2005.

The report also noted the U.S lags in the world when it comes to healthy life expectancy, ranking 28th after other major industrialized nations, including France, Germany, and the United Kingdom.

"This comparative information is extremely important because it is an indication that we as a nation have not achieved optimal health," Georges Benjamin, M.D., the executive director of American Public Health Association.

Reviewed by Zalman S. Agus, MD Emeritus Professor at the University of Pennsylvania School of Medicine

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